Bone cutting guide systems and methods

ABSTRACT

A bone cutting guide may include a support that contains a shaft movable relative to the support. The shaft may carry a guide member having one or more cut guides through which a clinician inserts a cutting member to cut bone positioned under the guide cut guides. In operation, a clinician may fixate the support of the bone cutting guide to a bone and translate the guide member until the one or more cut guides are positioned at a desired cut location. The clinician may then perform a cut through the cut guide. In some examples, the bone cutting guide includes additional components, such as bridging member or secondary cut guide, to provide additional functionality.

RELATED APPLICATION

This application claims the benefit of U.S. Provisional Application Ser.No. 62/100,641, filed Jan. 7, 2015, the entire contents of which arehereby incorporated by reference.

TECHNICAL FIELD

This disclosure relates generally to devices and methods for positioningand cutting bones.

BACKGROUND

Bones, such as the bones of a foot, may be anatomically misaligned. Incertain circumstances, surgical intervention is required to correctlyalign the bones to reduce patient discomfort and improve patient qualityof life.

SUMMARY

In general, this disclosure is directed to bone cutting guide systemsand techniques for cutting bones. In some examples, a bone cutting guideincludes a main body, or support, that houses a shaft that can translaterelative to the main body. The shaft may have a main guide memberpositioned on the end of the shaft. The main guide member may defineopposed guide surfaces configured to receive a cutting member. Forexample, the cutting member may be inserted between the opposed guidesurfaces and bounded within a range of movement by the guide surfaces,causing the cutting member to be directed at a cutting location underthe guide surfaces. Additionally or alternatively, the main guide membermay define a single cutting surface/plane. The cutting surface/plane maybe a surface against which a clinician can position a cutting member andthen guide the cutting member along the cutting surface/plane to performa cutting operation.

The main body of the bone cutting guide can include fixation members,such as fixation pins or apertures, that allow the main body to befixated on or adjacent a bone to be cut. For example, in use, aclinician may fixate the main body to a bone (e.g., a first metatarsal).Thereafter, the clinician may translate the main guide member having atleast one cutting guide surface (e.g., opposed cutting guide surfaces)relative to the fixed main body. The clinician can translate the mainguide member by sliding or rotating the shaft housed within the mainbody, e.g., causing the distal end of the shaft and main guide membercarried thereon away from or towards the main body. Once suitablypositioned, the clinician may or may not lock the location of the shaftand perform one or more cuts through the guide surfaces of the mainguide member.

In some configurations, the bone cutting guide also includes a bridgecomponent that can form a bridge over a section of bone, such as a jointbetween adjacent bones (e.g., first metatarsal-medial cuneiform joint).For example, the bridge component may have a proximal end that isattachable to the main guide member carried on the shaft attached to themain body and a distal end separated by one or more rails. The proximalend may be insertable between the opposed cutting guide surfaces of themain guide member, e.g., such that the proximal end of the bridge can beinserted between the guide surfaces after performing a cut through theguide surfaces. The distal end of the bridging member can includefixation members, such as fixation pins or apertures, that allow thedistal end of the bridging member to be fixated to bone. In oneapplication, the distal end of the bridging member is fixated to adifferent bone than the bone the main body is fixated to such that thebridging member spans a joint. In such applications, joint spacing maybe expanded or contracted by translating the shaft carried by the mainbody.

In addition to or in lieu of providing a bridging member, in someadditional configurations, the bone cutting guide may include asecondary guide member. The secondary guide member can be positioneddistally of the main guide member and may also include guide surfaces,such as opposed guide surfaces forming a channel sized and shaped toreceive a cutting member. The secondary guide member may facilitatemaking a second bone cut distal of a location where a first bone cut ismade using the main guide member.

In one example, a bone cutting guide is described that includes asupport defining an inner cavity and a shaft disposed at least partiallywithin the inner cavity, where the shaft is translatable within theinner cavity relative to the support. The bone cutting guide alsoincludes a main guide member located on an end of the shaft, where themain guide member includes a first guide surface defining a first planeand a second guide surface defining a second plane, and where the firstplane is parallel to the second plane.

In another example, a method for cutting bones is described. The methodincludes fixing a support to a bone and aligning a main guide member tobe positioned at a location to be cut. The method further includesmaking a first cut at the location to be cut by inserting a cuttingmember through a space defined between a first guide surface of the mainguide member and a second guide surface of the main guide member.

The details of one or more examples are set forth in the accompanyingdrawings and the description below. Other features, objects, andadvantages will be apparent from the description and drawings, and fromthe claims.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a side view of an embodiment of a bone cutting guide, withsome components shown in an exploded view.

FIG. 2 is a perspective view of the bone cutting guide of FIG. 1.

FIG. 3A is a perspective view of the bone cutting guide of FIG. 1 with abridge component attached to a main guide member.

FIGS. 3B-3D are top plan view illustrations of a bone cutting guide withdifferent example connecting blocks.

FIG. 3E is a side plan view of a bone cutting guide and an exemplarysupport.

FIG. 4 is a perspective view of the bone cutting guide of FIG. 1assembled.

FIG. 5 is another perspective view of the bone cutting guide of FIG. 4.

FIG. 6 is a further perspective view of the bone cutting guide of FIG.4.

FIG. 7 is a perspective view of a bone cutting guide support fixed to abone.

FIG. 8 is a top view of the bone cutting guide support fixed to the boneof FIG. 7.

FIG. 9 is a perspective view of the bone cutting guide support fixed tothe bone of FIG. 7 with a location of the main guide member adjusted.

FIG. 10 is a perspective view of a bridge component attached to the mainguide member of the support of FIG. 7 with a fixation structure attachedto the bridge component.

FIG. 11 is a perspective view of the fixation structure pinned across abone.

FIG. 12 is another perspective view of the pinned fixation structure ofFIG. 11.

FIG. 13 is a perspective view of the assembled bone cutting guide fixedto bones.

FIG. 14 is a further perspective view of the assembled bone cuttingguide of FIG. 13.

FIG. 15 shows a perspective view of the assembled bone cutting guide ofFIG. 13 with a secondary guide member translated along rails of thebridge component.

FIG. 16 is an additional perspective view of the assembled bone cuttingguide of FIG. 15.

DETAILED DESCRIPTION

The following detailed description is exemplary in nature and is notintended to limit the scope, applicability, or configuration of theinvention in any way. Rather, the following description provides somepractical illustrations for implementing exemplary embodiments of thepresent invention. Examples of constructions, materials, and dimensionsare provided for selected elements, and all other elements employ thatwhich is known to those of ordinary skill in the field of the invention.Those skilled in the art will recognize that many of the noted exampleshave a variety of suitable alternatives.

Embodiments of the present invention include a bone cutting guide. In anexemplary application, the bone cutting guide can be useful during asurgical procedure, such as a bone alignment, osteotomy, fusionprocedure, and/or other procedures where one or more bones are to becut. Such a procedure can be performed, for example, on bones (e.g.,adjacent bones separated by a joint or different portions of a singlebone) in the foot or hand, where bones are relatively smaller comparedto bones in other parts of the human anatomy. In one example, aprocedure utilizing the bone cutting guide can be performed to correctan alignment between a metatarsal (e.g. a first metatarsal) and acuneiform (e.g., a first cuneiform), such as a bunion correction. Anexample of such a procedure is a lapidus procedure. In another example,the procedure can be performed by modifying an alignment of a metatarsal(e.g. a first metatarsal). An example of such a procedure is a basilarmetatarsal osteotomy procedure.

FIGS. 1, 2, and 3A show an embodiment of a bone cutting guide 20 withsome components of the bone cutting guide 20 shown in an exploded view.FIG. 1 is a side view of the bone cutting guide 20, while FIGS. 2 and 3Aare perspective views of the bone cutting guide 20. The bone cuttingguide 20 can include a support 30 which defines an inner cavity 40 (FIG.2). In one embodiment, the support 30 can include a first fixationaperture 50A and a second fixation aperture 50B, each of which canextend through the support 30 and receive fixation pins 60A and 60B,respectively, such that the fixation pins 60A and 60B extend through thesupport 30 via the fixation apertures 50A and 50B. In the embodimentshown, the fixation pins 60A and 60B have a threaded first end adaptedto threadingly engage with a bone, and allow the support 30 to betranslated along a longitudinal axis of both pins 60A and 60B. In theillustrated embodiments, the fixation apertures 50A and 50B are locatedon opposite longitudinal ends of the support 30, but in otherembodiments the fixation apertures 50A and 50B can be located at variouspositions on the support 30.

The support 30 can further include one or more extensions 70A and/or 70Bprotruding generally radially out from the support 30, which may definea concave surface configured to receive a generally cylindrical boneportion. In the embodiment shown, fixation aperture 50B is provided withan extension member 72 which can be threadingly coupled to the support30. Such an extension member 72 can be adjusted relative to the support30 to allow the support to become parallel with a longitudinal axis of abone, if desired. In such embodiments, the support 30 can rest on a bonevia the extensions 70 A/B and extension member 72 in a positiongenerally parallel to the bone. Fixation pin 60B may be received withinan internal aperture of the extension member 72. As shown, apertures 74Aand B, such as tapered apertures, may be provided proximal to extensions70 A and B. Such apertures may extend through the support at a skewedangle relative to the longitudinal axis of the support, and may be usedto engage a clamping instrument or receive fixation pins.

The support 30 can also include a slot 80 formed on at least a portionof a surface of the support 30. As illustrated in the embodiment of thecutting guide 20 shown in FIG. 3A, the slot 80 can extend in a surfaceof the support 30 between fixation apertures 50A and 50B. A securingcomponent 90 can be configured to translate along the slot 80 relativeto the support 30. For example, the securing component 90 can have afirst end with a diameter greater than a diameter of a second oppositeend, such that the first end of the securing component 90 is supportedby the slot 80 (e.g., the first end has a diameter greater than a radialwidth of the slot 80) while the second end of the securing component 90is positioned within the slot 80 (e.g., the second end has a diameterless than a radial width of the slot 80).

The inner cavity 40 of the support 30 can have a shaft 100 positioned atleast partially within the inner cavity 40. The shaft 100 can beconfigured to translate within the inner cavity 40 relative to thesupport 30, such that an end of the shaft 100 can be made to project outfrom the inner cavity 40. The shaft 100 may define a slot 105 which maybe aligned with the slot 80 defined by the support 30. This slot 105 mayreceive the pin 60A to reduce interference when the shaft 100translates. Furthermore, the shaft 100 can include a securing aperture110 which can be configured to receive at least a portion of thesecuring component 90. In one embodiment, both the second end of thesecuring component 90, within the slot 80, and the securing aperture 110can be threaded to allow the securing component 90 to mate with thesecuring aperture 110. Such a configuration can allow the shaft 100 tobe fixed, such as by compressing a surface of the support 30 thatdefines the slot 80, and thus prevented from translating within theinner cavity 40, relative to the support 30. In another embodiment, thesecuring component 90 can be threadingly engaged with the support 30 toact against the shaft 100 to prevent the shaft 100 from traveling withthe cavity 40 when desired.

On an end of the shaft 100, a main guide member 120 can be disposed. Insome embodiments the main guide member 120 can be integral with theshaft 100, or in other embodiments the main guide member 120 and theshaft 100 can be separate components coupled together. The main guidemember 120 can have a first guide surface 130A and a second guidesurface 130B, and in some embodiments the main guide member 120 caninclude blocks 140A and/or 140B. The first and second guide surfaces130A and 130B can be adjacent surfaces facing one another with a spacedefined between the first and second guide surfaces 130A and 130B. Forexample, the first guide surface 130A can be a surface of the main guidemember 120 immediately opposite a surface of the main guide member 120that interfaces with the shaft 100, and the second guide surface 130Bcan be a surface of the main guide member 120 immediately opposite asurface of the main guide member 120 that includes blocks 140A and 140B.

In the illustrated embodiment, the second guide surface 130B contains agap, such that the second guide surface 130B is not a single, continuoussurface. In other embodiments, the second guide surface 130B can be asingle, continuous surface lacking any such gap. The first guide surface130A defines a first plane, while the second guide surface 130B definesa second plane. As shown, the first guide surface 130A and the secondguide surface 130B can be configured such that the first plane isparallel to the second plane, with the space between. In furtherembodiments (not illustrated), the guide surfaces 130A and 130B can beconfigured such that the first and/or second planes are skewed.

As previously noted, a surface of the main guide member 120 can includeone or more blocks 140A and 140B, either integral with the main guidemember 120 or as separate components attached to the main guide member120. As shown, the blocks 140A and 140B can be on a surface on a side ofthe main guide member 120 furthest from the interface with the shaft100. In other applications, the blocks 140A and 140B can be located atvarious other positions on the main guide member 120. The blocks 140Aand 140B can include fixation apertures 150A and 150B respectively. Thefixation apertures 150A and 150B extend through the blocks 140A and 140Band provide a location for configuring additional fixation pins to, forexample, position a bone or bones.

As shown in FIGS. 3B-3D, the main guide member 120 and at least oneblock 140A can assume other configurations. In FIG. 3B, the block 140Aincludes fixation apertures 150A and B and is spaced from the guidesurfaces a distance via connecting flanges 154A and 154B. In theembodiment of FIG. 3B, the fixation apertures 150A and B are positionedin a line substantially parallel to the guide surfaces. In FIG. 3C, theorientation of the fixation apertures 150A and B is substantiallyperpendicular to the guide surfaces. In FIG. 3D, only one fixationaperture 150A is provided.

Another embodiment of a support 30 is depicted in FIG. 3E. In FIG. 3E,the support 30 has at least one (e.g., two) fixation aperture 156A and156B formed in its side to receive fixation pins. Such apertures canalso be included on the opposite side of the support (not shown). Insome embodiments, the fixation apertures 156A and 156B can be positionedin a line substantially parallel with a longitudinal axis of thesupport, and can extend in a direction substantially perpendicular tothe longitudinal axis of the support. In certain embodiments, theapertures extend at an angle, such as about 20 degrees, from vertical.In such embodiments, the support 30 can be placed on a dorsal surfaceand after a first cut or cuts, can be rotated about a pin extendingthough one of the fixation apertures 156A and 156B to rotate the supportrelative to the bone and first cut or cuts. The support can then befurther pinned to the bone and an additional cut or cuts can be made ata desired angle relative to the first cut or cuts.

In addition to the support 30, the bone cutting guide 20 can include abridge component 160. As shown in FIG. 3A, the bridge component 160 canattach to the main guide member 120. In particular, in some applicationsof the bone cutting guide 20, the bridge component 160 can have ageometry that allows the bridge component 160 to attach to the mainguide member 120 between the first and second guide surfaces 130A and130B through an interference fit. Optionally, a locking mechanism can beprovided to lock the bridge component to the main guide member, such asa locking tab, screw, pin, cam, etc. For example, the bridge component160 may have a planar member 165 (shown in FIG. 2) that is receivedwithin the gap between the surfaces 130A and 130B and an extending block166 (shown in FIG. 2) adapted to extend into the surface gap of 130B. Inother applications, the bridge component 160 can be coupled to the mainguide member 120 by any attachment mechanism, such as screws or clamps.The bridge component 160 can include rails 170A and 170B, each extendingout from the bridge component 160 in a same general direction. In otherembodiments, the rails 170A and 170B can extend out from the bridgecomponent 160 at different angles.

The bone cutting guide 20 can also include in some embodiments afixating structure 180. The fixating structure 180 can be supported onthe rails 170A and 170B. For example, the fixating structure 180 caninclude apertures 185A and 185B to receive the rails 170A and 170B,respectively. The fixating structure 180 can be secured to the rails170A and 170B, such that the fixating structure 180 is obstructed fromtranslating along the rails 170A and 170B, by turning or otherwiseactuating an actuator 186 of the fixating structure 180, which moves alock (not shown) to act against the rails. Furthermore, the fixatingstructure 180 can also include one or more fixation apertures 190Aand/or 190B. Fixation apertures 190A and 190B extend through fixatingstructure 180 and can be located on opposite ends of the fixatingstructure 180, at a skewed angle, and serve to receive fixation pins orother means for stabilizing the bone cutting guide 20 across a targetedanatomy and/or positioning a bone or bones.

Additionally, the bone cutting guide 20 can have a secondary guidemember 200. The secondary guide member 200 can be supported on the rails170A and 170B. For example, the secondary guide member 200 may includeslots 205A and 205B to receive the rails 170A and 170B such that thesecondary guide member 200 is supported thereon. The secondary guidemember 200 can also have a third guide surface 210A and a fourth guidesurface 210B. The third and fourth guide surfaces 210A and 210B can beadjacent surfaces facing one another with a space defined between thethird and fourth guide surfaces 210A and 210B. In the illustratedembodiments, third and fourth guide surfaces 210A and 210B are single,continuous surfaces that do not include a gap, but in other embodimentsthird and/or fourth guide surfaces 210A and 210B can include a gap. Thethird guide surface 210A defines a third plane, while the fourth guidesurface 210B defines a fourth plane. As shown, the third guide surface210A and fourth guide surface 210B can be configured such that the thirdplane is parallel to the fourth plane, with the space between. Infurther embodiments (not illustrated), the guide surfaces 210A and 210Bcan be configured such that the third and/or fourth planes are skewed.Further, the third and/or fourth guide surfaces may be parallel to orskewed with respect to the first and/or second guide surfaces, such thatthe cutting guide can be adapted to make parallel cuts or angular cutsor cut shapes (e.g. a chevron shape). In some embodiments, the secondaryguide member 200 can be locked to the rails 170A and/or 170B with alocking screw, cam, pin, etc. In the embodiment shown in FIG. 3A, anaperture 214 is provided to receive a locking mechanism and/or anaccessory, such as a handle.

FIGS. 4-6 illustrate perspective views of the embodiment of the bonecutting guide 20, described with respect to FIGS. 1-3, as assembled. Inthe embodiment illustrated in FIGS. 4-6, the bridge component 160 isattached to the main guide member 120 and both the fixating structure180 and secondary guide member 200 are supported along the rails 170Aand 170B of the bridge component. In one application, the secondaryguide member 200 can be supported on the rails 170A and 170B at alocation along the rails 170A and 170B between the fixating structure180 and the main guide member 120. Additionally shown in FIGS. 4-6 arefixation pins 220A and 220B received within fixation apertures 190A and190B such that the fixation pins 220A and 220B extend through thefixating structure 180. In some applications of the bone cutting guide20, it may be desirable to provide the fixation pins 220A and 220B at anangle other than 90 degrees relative to a top surface of the fixatingstructure 180 by configuring the fixation apertures 190A and 190B toextend through the fixating structure 180 at a skewed angle to guide thefixating pins 220A and 220B. Fixation pins 220A and 220B can be used,for example, for stabilizing the bone cutting guide 20 across a targetedanatomy and/or positioning a bone or bones.

Embodiments of the bone cutting guide 20 can be useful in operation fortemporarily positioning a bone or bones and guiding a cutting of a boneor bones at a targeted anatomy. Bone cutting can be useful, forinstance, to facilitate contact between leading edges of adjacent bones,separated by a joint, or different portions of a single bone, separatedby a fracture, such as in a bone alignment and/or fusion procedure. Assuch, embodiments of the present invention include methods fortemporarily fixing an orientation of a bone or bones, such as during asurgical procedure, and guiding cutting at desired bone locations. Inthe embodiments described, cuts are made to bone with respect to thecutting guide, and the bones can be positioned for an additionalsurgical step, such as bone plating, after the cuts have been made.

FIGS. 7-16 illustrate steps of an embodiment of a method for temporarilypositioning and cutting a bone or bones using the bone cutting guide 20.Specifically, FIGS. 7 and 8 show a perspective and top view,respectively, of the support 30 fixed to a bone 230 (e.g. a firstmetatarsal). The support 30 is placed on the bone 230. For embodimentsof the bone cutting guide 20 that include the extensions 70A and 70B,the extensions 70A and 70B can be used to at least partially straddlethe bone 230 and consequently provide both greater stability to thesupport 30 on the bone 230 and anatomical alignment of the support 30 ona longitudinal axis of the bone 230 (e.g., the slot 80 is generallyparallel to the longitudinal axis of the bone 230). Extension member 72can be adjusted to a desired distance from support 30. Further, in someembodiments it can be desirable to align and fix the support 30 alongthe longitudinal axis of the bone 230 using the fixation pins 60A and60B. The pin 60A can be inserted through the fixation aperture 50A suchthat an end of the pin 60A protrudes out from the fixation aperture 50Aadjacent the bone 230. The pin 60A can then be fixed to the bone 230.Similarly, the pin 60B can be inserted through fixation aperture 50B andfixed on an end to the bone 230. In this manner, the support 30 can befixed in place to and aligned along the longitudinal axis of the bone230.

In addition to fixing the support 30 to the bone 230, the main guidemember 120 can be aligned such that the main guide member 120 ispositioned at a location where a bone (e.g., the bone 230) is to be cut.In one embodiment, the main guide member 120 can be positioned at thelocation where a bone is to be cut by appropriately positioning andfixing the support 30, e.g., such that the support 30 is fixed to thebone 230 at a location along bone 230 that results in the main guidemember 120 being positioned at the location where a bone is to be cut.In some embodiments, a joint alignment blade (not shown) is insertedthough the main guide member and into a joint space to help align themain guide member in a desired position. Further, in certainembodiments, a provisional fixation pin (not shown) can be insertedthrough a bone of interest and into an adjacent bone (e.g., though afirst metatarsal and into a second metatarsal) to provide additionalstability during the procedure.

In some applications, a location of the main guide member 120 relativeto the longitudinal axis of the bone 230 can be adjusted withoutnecessitating movement of the support 30. To accomplish this, the shaft100 at least partially within the inner cavity 40 can be translatedrelative to the support 30 as shown in the perspective view of FIG. 9.As shown, the main guide member 120 has been translated along thelongitudinal axis of the bone 230 a distance D as a result of the shaft100 being moved the same distance D. Once the main guide member 120 ispositioned at the location to be cut, the securing component 90 can betranslated along the slot 80 such that the securing component 90 isaligned with securing aperture 110. The securing component 90 can thenbe fixed within the securing aperture 110 such that the shaft 100 isfixed relative to the support 30.

After the main guide member 120 has been positioned at the location tobe cut, a cutting member (e.g. a saw blade) can be inserted through thespace defined between the first guide surface 130A and the second guidesurface 130B to cut, for example, the bone 230. The guide surfaces 130Aand 130B can serve to direct the cutting member to the location of thebone 230 to be cut, which in many applications can be a preciselocation. The break or window defined in the second guide surface 130Bcan assist in visualizing the portion of the bone 230 being cut.

In some embodiments, the main guide member 120 can be used to makeadditional cuts. In such embodiments, the securing component 90 can beloosened and the shaft 100 can be translated within the cavity to adesired position. The securing component 90 can be then be fixed withinthe securing aperture so the shaft is again fixed relative to thesupport 30. In some embodiments, fixation pins may be inserted throughfixation aperture 150A and/or 150B and into the bone 230 to furtherstabilize the main guide member. After the main guide member 120 hasbeen repositioned at the location to be cut, a cutting member (e.g. asaw blade) can be inserted through the space defined between the firstguide surface 130A and the second guide surface 130B to cut, forexample, the bone 240. The guide surfaces 130A and 130B can serve todirect the cutting member to the location of the bone 240 to be cut.

In some applications, it may be desirable to provide additional,temporary fixation of the bone 230 to allow for more accurate cutting.As best seen again in FIG. 9, blocks 140A and 140B can provide a meansfor additionally positioning the bone 230. Fixation pins can be insertedthrough the fixation aperture 150A and/or 150B and into the bone 230 totemporarily position the bone 230 and/or adjacent bone 240 for cutting.In other applications, blocks 140A and 140B may not be necessary.

As shown in the perspective view of FIG. 10, once the bone 230 has beencut the bridge component 160 can optionally be attached to the mainguide member 120. In one embodiment, the bridge component 160 can have ageometry that allows the bridge component 160 to attach to the mainguide member 120 between the first and second guide surfaces 130A and130B through an interference fit, while in other embodiments the bridgecomponent 160 can attach to the main guide member 120 by otherattachment means. The rails 170A and 170B of the bridge component 160can be arranged such that the rails 170A and 170B extend out from thebridge component 160 on a side of the bridge component 160 opposite thesupport 30. The rails 170A and 170B can serve to support additionalcomponents of the bone cutting guide 20.

One such component of the bone cutting guide 20 that can be supported onthe rails 170A and 170B is the fixating structure 180. FIG. 10 shows thefixating structure 180 attached to the rails 170A and 170B. In oneembodiment, the fixating structure 180 can have holes or slots forreceiving the rails 170A and 170B such that the fixating structure 180can translate along the rails 170A and 170B to a desired position. Thefixating structure 180, for example, can also be secured to the rails170A and 170B in a manner that prevents translation of the fixatingstructure 180 when desired by actuating the actuator 186.

FIGS. 11 and 12 illustrate perspective views of the fixating structure180 with the fixation pins 220A and 220B received through the fixationapertures 190A and 190B (190 B is shown in, e.g., FIG. 2). Fixationapertures 190A and 190B can be on opposite ends of the fixatingstructure 180 as shown. Fixation pins 220A and 220B can be fixed to abone 240 (e.g. a first cuneiform as illustrated) to provide stabilityfor the bone cutting guide 20 and/or to position the bone 240. After thepins 220A and 220B are set, the fixating structure 180 can be translatedwith respect to the rails 170A and 170B and the support 30 to a desiredposition to compress or expand the space between the bones 230 and 240as needed. The position of the bones can be locked by securing thefixating structure 180 against the rails 170A and 170B. In otherembodiments, such compression or expansion can be achieved by moving theshaft 100 relative to the support 30 and reengaging the securingcomponent 90 at the new desired position.

FIGS. 13 and 14 show perspective views of the bone cutting guide 20assembled to include the secondary guide member 200. The secondary guidemember 200 can be supported on the rails 170A and 170B. In oneembodiment, the slots 205A and 205B of the secondary guide member 200can receive the rails 170A and 170B such that the secondary guide member200 can translate along the rails 170A and 170B to a desired position.As illustrated, the secondary guide member 200 can be located along therails 170A and 170B between the fixating structure 180 and the bridgecomponent 160.

The secondary guide member 200 can be positioned at a location where asecond bone cut is to be made. A cutting member (e.g. a saw blade) canbe inserted through the space defined between the third and fourth guidesurfaces 210A and 210B to cut, for example, the bone 240. The guidesurfaces 210A and 210B can serve to direct the cutting member to thelocation of the bone 240 to be cut, which in many applications can be aprecise location. As illustrated, the cut made using the secondary guidemember 200 (e.g. to bone 240) will be a cut that is generally parallelto the cut made using the main guide member 120. However, in otherembodiments components of the bone cutting guide 20 (e.g. rails 170A and170B) can be configured such that the cut made using the secondary guidemember 200 is an angular cut (i.e. not parallel) relative to the cutmade using the main guide member 120.

FIGS. 15 and 16 illustrate the bone cutting guide 20 as describedpreviously, with the secondary guide member 200 translated along therails 170A and 170B. The secondary guide member 200 can be translatedalong the rails 170A and 170B to precisely locate the secondary guidemember 200 at the location to be cut (e.g. on bone 240). In theembodiment illustrated, the secondary guide member 200 can be shapedsuch that a portion of the secondary guide member 200 can overlap, orsit on top of, the bridge component 160. Such a configuration can beuseful, for example, where the second cut made using the secondary guidemember 200 is desired to be close to the first cut made using the mainguide member 120 (e.g. portions of bones 230 and 240 interfacing at ajoint).

When the bone 230 and/or bone 240 have been cut and positioned asdesired, the bone cutting guide 20 can be removed. In some embodiments,the cutting guide 20 is temporarily removed from the fixation pins andcut bone is removed from the area. In certain embodiments, an autograftor other compound is delivered to the area of the bone cuts. Optionally,the guide may then be reset on the bones over the fixation pins and theshaft 100 can be translated within the cavity to adjust the relativeposition of the bones (e.g., to compress them together). The securingcomponent 90 can be then be fixed within the securing aperture so theshaft is again fixed relative to the support 30. A bone plate mayoptionally be applied across the joint while the bones are held in thelongitudinally fixed position by the cutting guide. After the plate isapplied, the bone cutting guide and the fixation pins may be removed.Removing the bone cutting guide 20 can include removing all fixationpins and the support, and, in some embodiments, can include removing thebridge component, along with the fixation structure and secondary guidemember 200. In certain embodiments, a second bone plate may optionallybe applied across the joint. In a specific embodiment, the two boneplates are applied about 90 degrees from each other around thecircumferences of the bones (e.g., at a dorsal side and a medial side).

Thus, embodiments of the invention are disclosed. Although the presentinvention has been described with reference to certain disclosedembodiments, the disclosed embodiments are presented for purposes ofillustration, and not limitation, and other embodiments of the inventionare possible. One skilled in the art will appreciate that variouschanges, adaptations, and modifications may be made without departingfrom the spirit of the invention.

The invention claimed is:
 1. A bone cutting guide comprising: a supportdefining an inner cavity and having a length greater than a width; ashaft disposed at least partially within the inner cavity; and a mainguide member located on an end of the shaft, wherein the main guidemember includes a first guide surface defining a first plane and asecond guide surface defining a second plane, and the first plane isparallel to the second plane and extends in a dorsal to plantardirection, wherein the length of the support is configured to bepositioned parallel to a longitudinal axis of a bone to be cut to alignthe main guide member, and the shaft is configured to translate withinthe inner cavity relative to the support in a distal to proximaldirection parallel to the length of the support to move the main guidemember toward or away from the support.
 2. The bone cutting guide ofclaim 1, wherein the support includes first and second extensionsprotruded generally radially out from the support.
 3. The bone cuttingguide of claim 1, further comprising a first fixation aperture extendingthrough the support, Wherein a first fixation pin is configured toextend through the first fixation aperture to fixate the support.
 4. Thebone cutting guide of claim 3, further comprising a second fixationaperture extending through the support, wherein a second fixation pin isconfigured to extend through the second fixation aperture to fixate thesupport.
 5. The bone cutting guide of claim 4, wherein the firstfixation aperture and the second fixation aperture are located onopposite ends of the support.
 6. The bone cutting guide of claim 1,further comprising a slot defined on at least a portion of a surface ofthe support and a securing component configured to translate along theslot relative to the support.
 7. The bone cutting guide of claim 6,further comprising a securing aperture in the shaft configured toreceive the securing component such that the shaft can be fixed relativeto the support.
 8. The bone cutting guide of claim 1, wherein the mainguide member includes first and second blocks, and wherein a fixationaperture extends through the first block and another fixation apertureextends through the second block.
 9. The bone cutting guide of claim 1,further comprising a bridge component attached to the main guide member,wherein the bridge component includes first and second rails extendingout from the bridge component in a same direction.
 10. The bone cuttingguide of claim 9, wherein the bridge component is disposed between thefirst guide surface and the second guide surface.
 11. The bone cuttingguide of claim 9, further comprising a fixating structure supported onthe first and second rails.
 12. The bone cutting guide of claim 11,wherein the fixating structure includes a fifth fixation aperture on oneend of the fixating structure and a sixth fixation aperture on anopposite end of the fixating structure.
 13. The bone cutting guide ofclaim 9, further comprising a secondary guide member supported on thefirst and second rails.
 14. The bone cutting guide of claim 13, whereinthe secondary guide member is supported on the first and second rails ata location along the first and second rails between the fixatingstructure and the main guide member.
 15. The bone cutting guide of claim13, wherein the secondary guide member includes a third guide surfacedefining a third plane and a fourth guide surface defining a fourthplane, and wherein the third plane is parallel to the fourth plane. 16.The bone cutting guide of claim 1, wherein the first guide surface andthe second guide surface each extend perpendicularly relative to thelength of the support.
 17. A method for cutting bones, the methodcomprising the steps of: fixing a support having first and secondextensions to a bone by at least positioning the first and secondextensions in contact with the bone, inserting an end of a firstfixation pin through the support at a first fixation aperture in thesupport, and fixing the end of the first fixation pin to the bone;aligning a main guide member to be positioned at a location to be cut;and making a first cut at the location to be cut by inserting a cuttingmember through a space defined between a first guide surface of the mainguide member and a second guide surface of the main guide member. 18.The method of claim 17, wherein aligning the main guide member to bepositioned at the location to be cut comprises the step of: adjusting alocation of the main guide member relative to a longitudinal axis of thebone, wherein a shaft located at least partially within an inner cavitydefined by the support and to which the main guide member is attached istranslated relative to the support.
 19. The method of claim 18, furthercomprising the steps of: translating a securing component along a slotdefined on at least a portion of a surface of the support; and fixing atleast a portion of the securing component within a securing aperture ofthe shaft such that the shaft is fixed relative to the support.
 20. Themethod of claim 17, further comprising the step of attaching a bridgecomponent having first and second rails extending out from the bridgecomponent to the main guide member.
 21. The method of claim 20, whereinthe bridge component is attached to the main guide member between thefirst guide surface and the second guide surface.
 22. The method ofclaim 20, further comprising the step of: attaching a fixating structurehaving a second fixation aperture on one end of the fixation structureand a third fixation aperture on an opposite end of the fixationstructure to the first and second rails of the bridge component.
 23. Themethod of claim 22, further comprising the steps of: attaching asecondary guide member having a third guide surface and a parallelfourth guide surface to the first and second rails of the bridgecomponent; and making a second cut by inserting the cutting memberthrough a space defined between the third guide surface and the fourthguide surface.
 24. The method of claim 17, further comprising the stepsof: aligning the main guide member to be positioned at a second locationto be cut; and making a second cut at the second location to be cut byinserting the cutting member through the space defined between the firstguide surface of the main guide member and the second guide surface ofthe main guide member.